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Physician recognition of hypercholesterolemia in patients undergoing peripheral and carotid artery revascularization
K E Aspry1, J W Holcroft, E A Amsterdam
1Department of Internal Medicine, School of Medicine and Medical Center, University of California, Davis, USA.
Insights
Physicians inadequately address hypercholesterolemia in patients with peripheral and carotid atherosclerosis. Improved physician awareness and management of lipid disorders are crucial for these vascular disease patients.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Clinical Lipidology
Background:
- Peripheral and carotid atherosclerosis frequently coexist with hyperlipidemia.
- Lipid-lowering therapy can lead to regression of arterial plaque in femoral and carotid arteries.
- Physician attention to lipid risk factors in these patients remains unexamined.
Purpose of the Study:
- To evaluate physician recognition and management of hypercholesterolemia in patients with peripheral and carotid occlusive disease.
- To assess screening, documentation, in-hospital management, and discharge intervention for hypercholesterolemia.
Main Methods:
- Retrospective chart review of 80 consecutive patients undergoing revascularization for symptomatic peripheral and carotid occlusive disease (1990-1993).
- Assessment of physician practices regarding hypercholesterolemia screening, documentation, management, and discharge intervention.
Main Results:
- 73% of patients had perioperative lipid case-finding, but only 25% were assessed for hyperlipidemia by the physician.
- Of hypercholesterolemic patients (66%), only 16% had documented hypercholesterolemia, 24% received in-hospital management, and 13% received discharge intervention.
- Significant gaps exist in the recognition and management of hypercholesterolemia.
Conclusions:
- Patients with peripheral and carotid atherosclerotic vascular disease likely receive insufficient attention to lipid risk factors.
- There is a clear need for increased physician awareness and improved management strategies for lipid disorders in these patient populations.
Abstract:
Numerous studies have shown that patients with peripheral and carotid atherosclerosis have a high prevalence of hyperlipidemia, and clinical trials using either angiography or ultrasonography have now demonstrated regression of both femoral and carotid arterial plaque during lipid-lowering therapy. However, whether patients with peripheral and carotid atherosclerosis receive adequate attention to lipid risk factors has not been studied. To evaluate physician recognition and management of hypercholesterolemia in these two patient populations, we reviewed the charts of 80 consecutive patients undergoing revascularization for symptomatic peripheral and carotid occlusive disease at a university medical center between 1990 and 1993. Physician practices were assessed for each patient by noting whether hypercholesterolemia was (1) screened for during the hospitalization and, if present, (2) documented as a problem, (3) managed in-hospital, or (4) given appropriate intervention at discharge. While 73% of patients received some type of lipid case-finding perioperatively, less than one quarter of these were assessed for hyperlipidemia by the physician during the initial history. Moreover, of the 66% of screened patients found to be hypercholesterolemic, only 16% had documentation of the problem, only 24% received in-hospital management, and only 13% received intervention at discharge. These findings suggest that patients with documented peripheral and carotid atherosclerotic vascular disease probably receive inadequate attention to lipid risk factors and indicate the need for greater awareness and management of lipid disorders in these two patient populations by all involved physicians.